Management of SA oesophageal and gastric SA disease Flashcards Preview

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Flashcards in Management of SA oesophageal and gastric SA disease Deck (39)
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1
Q

Which gastric and oesophageal diseases need surgery? (5)

A
  • Foreign bodies that can’t be removed endoscopically or where this is not feasible?
  • Gdv!
  • Hiatal hernia
  • Vascular ring anomaly?
  • Pyloric outflow tract obstruction?
2
Q

When would you not investigate gastric and oesophageal disease? (3)

A
  • Acute cases?
  • Possibility/likelihood of self limiting disease
  • Patient is generally well (albeit with a problem)
3
Q

What general supportive care can we give to a GI patient?

A
  • Oral fluids – small volumes frequently
  • S/c fluids for mild dehydration
  • Starve 24h/small volume liquid diets
  • Introduce bland, highly digestible diet e.g. fish and rice
    • Small, frequent meals
      • Low fat, high quality protein à promotes stomach emptying
    • Gradual transition back to normal
  • Consider use of anti emetics +/- gastroprotectants (??)
  • Remember time is a healer: “tincture of time”
  • Always suggest: call or revisit if not VMB in 24 hours (very much better)
4
Q

Why is nutrition so important to the gut? (3)

A
  • Supports mesenteric perfusion (which includes the pancreas)
  • Provides trophic factors to repair and maintain the intestinal mucosa
  • Helps normalise intestinal motility
5
Q

How long does it take for a cat to suffer metabolic consequences from anorexia?

A

3-4 days

6
Q

What is cachexia?

A
  • metabolic derangement not “just” severe wt loss
  • reduced energy intake
  • increased requirements
  • pro inflammatory state
7
Q

Name a formula to calculate nutriotional requirements (there are 2)

A
  • 70 x bodyweight in kg0.75
  • RER= (30 x current body weight in kg) + 70
8
Q

What do we need to consider when choosing an appropriate diet?

A
  • Digestibility?
  • Special requirements?
  • Low fat diet for pancreatitis dogs?
  • Single source or hydrolysed protein diet for suspected food intolerance cases? Or even a specific exclusion diet for an IBD patient down a tube
  • Balanced diet for young cats with nutritional hyperparathyroidism?
  • Is the diet practical?
9
Q

What is a oesophageal feeding tube good for? What do we need to use?

A
  • Head trauma
  • Need a GA and not good for oesophageal disease
10
Q

Name 3 nutrional support techniques

A
  • Tempt feeding
  • Hand feeding
  • Syringe feeding
11
Q

What are the risks of providing nutritional support?

A
  • Food aversion with the more you try to force feed a cat
  • Aspiration
  • Further weight loss
  • False sense of security
12
Q

Name a appetite stimulant

A

Mirtazapine

13
Q

What dose is used for mirtazepine and why?

A

Lower dose the better - in case the animal has kidney or liver disease and the drug will be excreted by either of these methods.

14
Q

Mirtazapine:

A) What role does it have?

B) Is it licensed?

A

A) Palliative

B) No

15
Q

What skill is needed for placing feeding tubes?

A

little

16
Q

Which feeding tube is a GA not needed?

A

Naso-oesophageal

17
Q

Whic tube can be in place for weeks to months?

A

Gastrotomy

18
Q

What things do we need to consider when choosing a feeding tube?

A
  • Is it “safe” to GA or sedate?
  • How long might we need the tube for?
  • What type of diet needs to be fed?
  • Will this affect my patient’s lifestyle?
  • The animal should not go out
  • They can eat with this tube in
19
Q

Where should you secure naso-oesophageal tube? Why?

A

Secure at the top of the head as this is less irritating

20
Q

What is the lomitation of a naso-oesophageal tube?

A

Size of the tube and there will be some irritation at the external nares

21
Q

Discuss the issues of a PEG tube

A

Percutaenous endoscopic gastrotomy (PEG) tubes require some endoscopy skills and carry more risks for the patient than an O tube

Strap them in – prevent them getting caught

Coming from stomach to the flank

Should be in place for 7-10 days. When you pull the oesophageal tube out (likelihood oesophagus wont leak in cervical region) but I this tube comes out there is a stomach with a hole floating around in the abdomen with fluid and acid which will lead to peritonitis. Keep minimum 7-10days heals and creates a stoma so you get a blowhole from stomach out abdomen wall. Heal over gradual. Wont leak into the abdo cavity which is the key thing

More catatrophic if this comes out than a cat pulling at an oesophageal tube

22
Q

What is there a risk of when positional feeding?

A

Aspration pneumonia

23
Q

How should vertical feeding be done?

A

Want head above stomach

But need head vertical above stomach if we can

Bailey chairs can be helpful but often hand feeding a dog sitting down

Feeding them up a stairway may help

24
Q

Why the type of food used might be important in our GI cases?

A
  • Hills
  • Royal canin (waltham)
  • Eukanuba
  • Purina
25
Q

Define adverse food reaction

A

Any clinically abnormal response attributed to the ingestion of a food or food additive. Adverse food reactions are categorized as either food allergy or food intolerance reactions.

26
Q

Define food allergy

A

•immunologically mediated adverse reaction to food unrelated to any physiological effect of the food or food additive.

27
Q

Define food intolerance

A

Any abnormal physiologic response to a food that is not believed to be immunologic in nature and may include food poisoning, food idiosyncrasy, pharmacologic reaction, or metabolic reaction.

28
Q

How reliable are serum IgE tests for GI disease?

A

unreliable

29
Q

What is the useful way to assess food allergy/intolerance?

A

Lol i fooled ya…

there isn’t a useful way

30
Q

What do we select a GI disease diet based on (2)?

A
  • Previous diet history
  • Careful application of trial and error
31
Q

When would we use an exclusion diet in GI disease? (2)

A
  • Appropriate clinical signs
  • Underlying disease ruled out
32
Q

What protein do we feed in an exclusion diet?

A
  • Single source?
  • Novel?
  • Hydrolysed
33
Q

What considerations do we need to have when using an exclusion diet? (5)

A
  • Home cooked or commercial?
    • No other feed can be given
  • How long do we use the diet for? 2-8 weeks min
  • Should we try a different diet if the first one doesn’t work?
  • If there is clinical improvement what happens next?
34
Q

What are we hoping for when using an exclusion diet?

A

a maintained trend of improvement

reduced frequency and severity of clinical signs

35
Q

When should we investigate a GI disease (3)

A
  • suspect problem is not self limiting
  • patient deteriorating
  • demanding owners?
36
Q

What 3 things do we check when reviewing a case?

A
  • history
  • physical examination
  • owners hopes and expectations
37
Q

What 3 things does fluid therapy correct?

A
  • fluid deficits
  • electrolyte imbalances
  • restores acid-base balance
38
Q

What do we have to do prior to surgery even if an emergency?

A

Stabilise the patient

39
Q

What 3 electrolyte abnormalities may manifest in GI obstruction?

A
  • hypochloraemia
  • hypokalaemia
  • hyponatraemia

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